title: Trends in quality of care among patients with incident heart failure in Denmark 2003-2010: a nationwide cohort study.
abstract: BACKGROUND
  The treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care and clinical outcome of HF patients using indicator monitoring combined with systematic auditing.
  
  
  METHODS
  We conducted a nationwide, population-based prospective study using data from the Danish Heart Failure Registry. The registry systematically monitors and audits the use of guideline recommended processes of care at Danish hospital departments treating incident HF patients. We identified patients registered between 2003 and 2010 (n = 24,504) and examined changes in use of recommended processes of care and 1-year mortality.
  
  
  RESULTS
  The use of the majority of the recommended processes of care increased substantially from 2003 to 2010: echocardiography (from 62.7% to 90.5%; Relative Risk (RR) 1.45 (95% CI, 1.39-1.50)), New York Heart Association classification (from 29.4% to 85.5%; RR 2.91 (95% CI, 2.69-3.14)), betablockers (from 72.6% to 88.3%; RR 1.23 (95% CI, 1.15-1.29)), physical training (from 5.6% to 22.8%; RR 4.04 (95% CI, 2.96-4.52)), and patient education (from 49.3% to 81.4%; RR 1.65 (95% CI, 1.52-1.80)). Use of ACE/ATII inhibitors remained stable (from 92.0% to 93.2%; RR 1.01 (95% CI, 0.99-1.04)). During the same period, 1-year mortality dropped from 20.5% to 12.8% (adjusted Hazard Ratio 0.79 (95% CI, 0.65-0.96).
  
  
  CONCLUSIONS
  Use of guideline recommended processes of care has improved among patients with incident HF included in the Danish Heart Failure Registry between 2003 and 2010. During the same period, a decrease in mortality was observed.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. anne.nakano@stab.rm.dk.
authors.forename: Anne
authors.initials: A
authors.lastname: Nakano
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
authors.forename: Birgitte Lidegaard
authors.initials: BL
authors.lastname: Frederiksen
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Svendsen
authors.forename: Carsten
authors.initials: C
authors.lastname: Agger
authors.forename: Inge
authors.initials: I
authors.lastname: Schjødt
authors.forename: Kenneth
authors.initials: K
authors.lastname: Egstrup
mesh_terms: D000368:Aged; D003718:Denmark / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D058996:Quality Improvement / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012042:Registries